AstraZeneca US, Gaithersburg, MD, USA.
Optum, Eden Prairie, MN, USA.
Cancer Med. 2020 May;9(10):3463-3476. doi: 10.1002/cam4.3011. Epub 2020 Mar 25.
Pancreatic cancer represents the third leading cause of US cancer deaths, with median survival <1 year. The goal of this study was to describe systemic treatments, healthcare utilization and costs, and overall survival among patients with unresectable/metastatic disease.
This study used healthcare claims for commercial and Medicare Advantage enrollees diagnosed with pancreatic adenocarcinoma (at index date) during January 01 2010 to 31 May 2017. Included patients were aged ≥18 years, with continuous 6-month preindex enrollment. Patients were excluded by resectable disease, another primary cancer, or pregnancy. Cohorts were based on first-line (LOT1) chemotherapy regimen.
Overall, 12 978 patients (mean age 70 years, 51% male) were included, among which 5610 (43%) received chemotherapy. Of those, 23% received gemcitabine monotherapy, 22% gemcitabine-nab paclitaxel, 22% FOLFIRINOX, 3% FOLFOX, and 29% received other regimens. Mean LOT1 duration was 112 days; 60% did not undergo subsequent lines of therapy. Moreover, 50% of patients had an emergency room visit and 45% were hospitalized during LOT1. Among treated and untreated patients, mean total 6-month costs were $52 101. We found that patients receiving FOLFIRINOX had the highest costs, whereas those who received gemcitabine monotherapy had the lowest. Median overall survival (mOS) was 335 days with any first-line treatment. FOLFIRINOX-treated patients had the highest mOS (492 days), whereas gemcitabine monotherapy-treated patients had the lowest (223 days).
A large proportion (57%) of patients with unresectable/metastatic pancreatic cancer did not receive chemotherapy. Healthcare costs were higher for fluorouracil-based regimens, while lower for gemcitabine-based regimens. Survival rates were within expectations for advanced pancreatic cancer.
胰腺癌是美国癌症死亡的第三大主要原因，中位生存期<1 年。本研究的目的是描述不可切除/转移性疾病患者的系统治疗、医疗保健利用和成本以及总生存率。
本研究使用了 2010 年 1 月 1 日至 2017 年 5 月 31 日期间接受商业和医疗保险优势计划的患有胰腺腺癌（索引日期）的患者的医疗保健索赔。纳入患者年龄≥18 岁，且有连续 6 个月的预索引登记。排除可切除疾病、另一种原发性癌症或妊娠的患者。队列基于一线（LOT1）化疗方案。
总体而言，纳入了 12978 名患者（平均年龄 70 岁，51%为男性），其中 5610 名（43%）接受了化疗。其中，23%接受了吉西他滨单药治疗，22%接受了吉西他滨-白蛋白紫杉醇，22%接受了 FOLFIRINOX，3%接受了 FOLFOX，29%接受了其他方案。LOT1 平均持续时间为 112 天；60%的患者未接受后续治疗。此外，50%的患者在 LOT1 期间接受了急诊治疗，45%的患者住院。在接受治疗和未接受治疗的患者中，平均 6 个月的总费用为 52101 美元。我们发现，接受 FOLFIRINOX 治疗的患者费用最高，而接受吉西他滨单药治疗的患者费用最低。任何一线治疗的中位总生存期（mOS）为 335 天。接受 FOLFIRINOX 治疗的患者 mOS 最高（492 天），而接受吉西他滨单药治疗的患者 mOS 最低（223 天）。
不可切除/转移性胰腺癌患者中（57%）很大一部分患者未接受化疗。氟尿嘧啶类方案的医疗保健费用较高，而吉西他滨类方案的费用较低。生存率符合晚期胰腺癌的预期。
